Monthly Archives: August 2016

I read online that viewership of the 2016 Rio Olympics is down. That was news to me, since I have been glued to the television during all of the swimming, diving and gymnastics events. I don’t read the spoiler alerts on the news and in social media, because I want to watch each event with nervous anticipation and hopefulness. I love to be surprised by the results!

As you know, swimming is a favorite sport of mine – more so lately because my grandson, Jack, participates in the sport. In my last two Friday Flash reports, I told the story of his most recent meet, as I watched him swim in adversity and finish his first race with his goggles lodged between his nose and mouth; then, I had a chance to see him finish in fifth place for his 100-meter backstroke event. He had told me all about his strategy to improve his time, and in his last race, the 200-meter freestyle, I learned even more about Jack as he once again put his strategy to work—he shaved a full 15 seconds off his personal best time and finished in fourth place!

Last week, I used Jack’s story to talk about our own strategy for success when it comes to Best Care. Our vision is to not only deliver the safest care to every patient, every time, but we are also challenging ourselves to rank among the top 20 academic medical centers for quality and patient safety*. This week, something happened to reassure me that we can and will meet this very aggressive goal.

As a participant in the Medicaid program, which provides medical coverage for more than 4 million low-income Texans, UTMB takes part in its pay-for-performance program. Simply put, the program has two basic elements upon which we are rated: potentially preventable readmissions (PPR) and potentially preventable complications (PPC).

The penalties are not insignificant. When the program began three years ago, UTMB had $3.5 million of its Medicaid payments withheld due to unplanned readmissions and complications. We were astonished. But, as we looked into the data, it became clear that a good deal of the reimbursements were withheld not because of the quality of the care provided, but rather because our documentation and coding was not sufficient; therefore, it did not accurately reflect the degree of our patients’ illnesses or the specificity of their complications. In response, we set out on a mission to improve our documentation and coding, as well as to review every unplanned readmission.

The results the following year were incredible—instead of the $3.5 million figure being withheld, we had reduced the amount to a $2.5 million—all from readmissions. Following this significant improvement, we planned to further reduce this amount in FY16 by at least another million by sustaining our gains in reducing readmissions and focusing on preventing complications.

Because our Medicaid population is heavily represented by mothers and children, we talked to the department leaders, we rolled up our sleeves and reviewed OB charts with identified complications, brought in experts in the 3M PPR and PPC algorithms, and shared findings and recommendations with faculty and residents, informing them of the implications for their ongoing documentation. As a result of that work, a physician leader reviewed each case forwarded by hospital coders. The physician then communicated clarifications to the individuals involved in that patient’s care and medical record, and provided any overall messaging that would be useful in guiding the entire department.

While documentation and coding were certainly high contributors to the outcomes, there were also some process changes that helped us turn the information into actions that improved our overall care. The team engaged partners in Information Services to make changes in the Epic EMR infrastructure that would better facilitate the identification of the complexity and co-morbidity of OB patients, and to guide the assignment of observation status as appropriate (thereby avoiding an inpatient readmission).

The result? This week, we received our report from Medicaid outlining our results for the 2015 performance period, which go into effect September 1, 2016. We had zero deductions for unplanned readmissions and zero deductions for unplanned complications of care. That’s right—we exceeded our plan, and we did not incur ANY of the potential $2.5 million penalty!

This outcome reinforced several things for me:

We need a plan that we follow without exception.

We need people to be engaged in this effort to help us identify problem areas, develop solutions to those problem areas, and be willing to assist in teaching and educating our providers and staff to help us achieve our goal.

We can achieve lofty, seemingly impossible goals, if we have a plan, execute it and stay singularly focused on achieving it.

While I would like to think that the large amount we retained will help our budget next year, we also learned that some of our funding from other various sources will be reduced more than we had anticipated. So while the latter is disheartening, it is another reason why we are so focused on Best Care—safer care is not only better for our patients, but it costs less, too.

If we remain focused on meeting the performance benchmarks for academic medical centers, increase our efficiency, reduce variation in care, and improve our quality, everyone wins. We lower our costs, see greater reimbursement, and most importantly, our patients get the best possible care—thisis our ultimate goal.

We have a tremendous opportunity to showcase our talent and expertise through this endeavor. Thank you all for everything you are doing to help UTMB Health achieve Best Care for all of its patients!

Last week, I shared a story about my grandson, Jack, who recently competed in a swim meet. During one of his races, he swam four laps with his goggles between his nose and his mouth after they were dislodged upon diving into the pool. Despite this obstacle, Jack finished the race. I thought this story was a great example of the importance of staying the course to achieve our goals, despite the obstacles we may encounter along our way.

After this race, Jack had a little bit of time for lunch before he swam in his next two events. As the time approached for the 100-meter backstroke, he sat down next to me. Instead of asking him if he was nervous, I asked about his goal for his heat. He told me that he wanted to improve his time and finish in the top eight, which would earn him a ribbon.

“So, you have a plan?” I asked.

“Yes,” he said. (He is a boy of few words – or maybe it is just that he is 10!)

“How did you get that plan?” I asked. (Jack thinks his Nana asks a lot of questions, but I tell him I had many years of practice when his mom was young!)

“I worked with my coach.” He said. “She had me practice my dive into the water and my turns. My coach and I talked about what I needed to do to improve my stroke, and we talked about my plan for swimming the race.”

Then he told me about how he would try to get a good entry into the water, move under the water as long as he could, swim hard the first lap, pace himself, and then give it all he had toward the finish.

“Do you feel it is a good plan, one that will work for you?” I asked.

Jack nodded.

“Then go do it, Jack, because I know you can.”

As he dove into the water a few minutes later, I held my breath, hoping that his plan would pay off and he would meet his goal. A few minutes later, Jack had finished in the top five!

I thought about what Jack had done – how he had prepared for and swam his race. I realized how similar this is to what we are doing in the next twelve months to achieve our Best Care goal:

We have selected the races that will help us rank among the best. In other words, we have identified several areas of focus in quality and safety – mortality, readmissions, length of stay and patient safety – that will help us improve the most and place us among the best academic medical centers in the country, as measure by Vizient’s Quality & Accountability Study. We also know we must maintain our success in patient-centeredness and equity, as well as remain focused on clinical documentation improvements and enhancing the Epic EMR to be successful.

We have set challenging but achievable targets. Working together, Health System leadership, the Provost & Dean of the School of Medicine, and the Clinical Chairs identified measurable goals that we believe we can achieve within the coming year—as long as we work together and maintain our commitment, dedication and focus. Learn more about these measures on the Best Care website.

We will coach ourselves so we always know how well we are performing and where we need to increase our focus to improve. Teams across the Health System have created reports that can be accessed on the Process Improvement Dashboard to help us track our progress. Clinical Chairs and unit leaders can access these reports, identify areas for improvement on an ongoing basis, and help lead their teams to success.

We believe we can do it! Above all, we believe we can be the BEST, because know at UTMB Health, we have the talent and expertise – and most of all, we have the passion – to deliver a safe, reliable care environment and an excellent patient experience to every patient, every time.

“Desire is the key to motivation, but it is determination and commitment to an unrelenting pursuit of your goal – a commitment to excellence – that will enable you to attain the success you seek.”

Several weeks ago, my grandson, Jack, swam in a large meet in the Houston area. Jack has been a swimmer for almost two years, and he swims in the 10-year-old category. This particular meet was very illuminating to me, because what happened to Jack told me something about his character.

This particular Saturday, Jack was scheduled for three events: the 100-meter freestyle, 100-meter backstroke and 200-meter freestyle. His first event, the 100-meter freestyle, should have been his best. However, as he dove into the pool for his heat, his goggles were not on tightly enough and they ended up just below his nose with his mouth partially covered by them.

I could tell from where I sat that he was upset and struggling. The same thing happened to another swimmer in the heat. Jack swam four laps in the 25-meter pool and finished in 14th place out of 53 swimmers. The other swimmer whose goggles had also slipped pulled himself out of the pool after the first lap, and in a fit of defeat, threw his goggles into the practice pool.

When Jack got out of the pool, he was also very upset. This was his best event, and he knew if the goggles had stayed in place, he would have placed in the top eight in this event—practice after practice, that had been his goal. Now, he did hadn’t even placed in the event.

A little later, as we were waiting for Jack’s next event, I talked to him about his experience and told him he should be proud of what he accomplished. While the other swimmer had given up, Jack finished his race despite the obstacle in his way.

What happened to Jack caused me to think about how many times we have to keep going despite adversity so that we can finish, and at times, finish strong. This is true in the workplace, in our personal lives, and it’s true for our patients and their loved ones. Every day, we each have a choice as to how we will meet our challenges. We have a choice as to whether or not we are willing to overcome the barriers that get in our way, or if we will give up, even despite all of the hard work we have put in so far.

When it comes to Best Care, we have set the bar high, and we have some tall orders ahead of us when we consider we have to simultaneously improve in mortality, readmissions, length of stay and patient safety events. At times, it may be tempting to throw in our goggles after one bad race, but that doesn’t mean giving up is the right thing to do—for ourselves or our patients. We make a choice each day to keep swimming and finish the race!

We may face adversity when it comes to helping a patient with multiple illnesses get well enough for discharge.

It may be a challenge to help patients who will require some level of care outside of the hospital setting; however, they may not have the resources to acquire that care.

It may be a challenge to help some patients learn about healthy lifestyle choices or to help them find the resources they need to avoid readmission.

We may do everything in our power to create a plan of care that meets all of a patient’s needs, but they may have trouble following their care plan or will simply not comply.

Not all patients and families begin at the same starting line—even though there may be a patient whose length of stay extends beyond what we hoped, we know we must stay the course until that patient is well enough to go home, because it’s the right thing to do.

We will face challenges on our own teams at times—perhaps there will be disagreement among team members or lapses in communication.

It is said that when beginning a journey, start by doing what’s necessary; then do what’s possible; and suddenly you are doing the impossible. Whatever challenges may come, we must stay focused and remember to break these large areas of focus—readmissions, mortality, length of stay, and patient safety events—into effective and manageable tasks, like using the 8 Ps, working together during progression of care rounds, and improving our use of the medical record. All of these seemingly smaller efforts will begin to align and will get us to our goal more quickly than waiting for one big opportunity to come along.

Remember: Determination, patience and courage are the only things needed to improve any situation! Whatever our obstacles to Best Care may be, let’s continue to work together, focus on our goals, and finish our race strong!